HomeMy WebLinkAbout1407 Shortleaf St - Applications/Air Conditioner - 09/02/2011Planning, Development & Transportation
City
}Of 281 N. College Ave P.O. Box 580
F6r` Collins Fort Collins, CO 80524
�.� Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 6Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 131' 0 L0Date
For office use only
Job Site Address (required) 1 Value of Construction (labor, materials, profit)
-P_? T— $
Property Owner Name
Address
City/State , Zip
Phone
o
i
S�
Applicant Name
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
sales tax number isrequired byall contractors.
Are you paying with your trust account? ❑ Yes
B-1417-
Is this a residential.or commercial project? 20%esidential ❑ Commercial
If residential, is it: E'S ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes EM6 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Apply �/
Print Name: Sig Date �r/3